Archive for March, 2011


March 31, 2011

“Winners never quit and quitters never win.”  -Vince Lombardi


Cowtown Netweavers 03.30.2011

March 30, 2011

Today was a presentation by Mike McCaleb.  These were my takeaway’s:

  • You make choices to be optimistic
  • Believe in Your Heart, Train for it, and Proclaim it
  • It is not the hits you take but how you get back up
  • Set Goals

How can I prepare for ICD-10?

March 28, 2011

What can I do to prepare for ICD-10-CM?

While there will need to be significant education and training for physicians, coders and other health care personnel to fully implement this major code change, no one needs to panic. Other organizations are already attempting to capitalize on the situation by suggesting that coders should begin training immediately. The AAPC does not believe such an approach is either necessary or prudent since it will likely be difficult to remember in three or four years what you were trained on today.

The AAPC has a plan in place to provide accurate and timely assistance to permit you to effectively implement ICD-10 on time.  The plan is broken down by year (2009 – 2013) and includes a variety of delivery methods, such as Webinars, audio conferences, onsite training and national and regional conferences. A team of leading coding and ICD-10 experts developed the plan, which is broken into benchmarked steps.

As part of the implementation plan, the AAPC has provided its members with a “Personal Progress Tracker,” which gives members the ability to easily enter in personal progress with red, yellow and green lights that indicate whether the member is on schedule or not. More information, including the detailed plan and training program, is available on the AAPC’s Web site at


March 24, 2011

“Whenever an individual or a business decides that success has been attained, progress stops.”  -Thomas J Watson

What is ICD-10?

March 21, 2011

What is ICD-10?

ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in 1993 to replace ICD-9, which was developed by WHO in the 1970s. ICD-10 is in almost every country in the world, except the United States.

When we hear “ICD-10” in the United States, it usually refers to the U.S. clinical modification of ICD-10: ICD-10-CM. This code set is scheduled to replace ICD-9-CM, our current U.S. diagnostic code set, on Oct. 1, 2013.

Another designation, ICD-10-PCS, for “procedural coding system,” is will also be adopted in the United States. ICD-10-PCS will replace Volume 3 of ICD-9-CM as the inpatient procedural coding system. Current plans would see CPT remain the coding system for physician services.

More information on WHO’s ICD-10 code set can be found at

When will ICD-10-CM and ICD-10-PCS be implemented?

The Department of Health and Human Services (HHS) announced on August 15, 2008, a long-awaited proposed regulation that would replace the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10-CM (diagnosis) and ICD-10-PCS (hospital procedure) code sets. In a separate proposed regulation, HHS has proposed adopting the updated X12 standard, Version 5010, and the National Council for Prescription Drug Programs standard, Version D.0, for electronic transactions, such as health care claims. Version 5010 is essential to use of the ICD-10 codes.

The Centers for Medicare and Medicaid Services (CMS) announced in January that ICD-10-CM will be implemented into the HIPAA mandated code set on Oct. 1, 2013. The American Academy of Professional Coders (AAPC) lobbied successfully to delay implementation beyond its initial 2010 proposed date, and more recently to delay a proposed 2011 date, believing that it would create undue hardships in the industry, as it falls too soon on the heels of other significant regulatory changes that have burdened providers in recent years.

Why is the United States moving to ICD-10-CM?

ICD-9-CM has several problems. Foremost, it is out of room. Because the classification is organized scientifically, each three-digit category can have only 10 subcategories. Most numbers in most categories have been assigned diagnoses. Medical science keeps making new discoveries, and there are no numbers to assign these diagnoses.

Computer science, combined with new, more detailed codes of ICD-10-CM, will allow for better analysis of disease patterns and treatment outcomes that can advance medical care. These same details will streamline claims submissions, since these details will make the initial claim much easier for payers to understand.

How is ICD-10-CM different from our current system?

In many ways, ICD-10-CM is quite similar to ICD-9-CM. The guidelines, conventions, and rules are very similar. The organization of the codes is very similar. Anyone who is qualified to code ICD-9-CM should be able to easily make the transition to coding ICD-10-CM.

Many improvements have been made to coding in ICD-10-CM. For example, a single code can be found to report a disease and its current manifestation (i.e., type II diabetes with diabetic retinopathy). In fracture care, the code differentiates an encounter for an initial fracture; follow-up of fracture healing normally; follow-up with fracture in malunion or nonunion; or follow-up for late effects of a fracture. Likewise, the trimester is designated in obstetrical codes.

While much has been said about the huge increase in the number of codes under ICD-10-CM, some of this growth is due to laterality. While an ICD-9-CM code may identify a condition of, for example, the ovary, the parallel ICD-10-CM code identifies four codes: unspecified ovary, right ovary, left ovary, or bilateral condition of the ovaries.

The big differences between the two systems are differences that will affect information technology and software at your practice. Here’s a chart showing the differences:

Issue ICD-9-CM ICD-10-CM
Volume of codes approximately 13,600 approximately 69,000
Composition of codes Mostly numeric, with E and V codes alphanumeric. Valid codes of three, four, or five digits. All codes are alphanumeric, beginning with a letter and with a mix of numbers and letters thereafter. Valid codes may have three, four, five, six or seven digits.
Duplication of code sets Currently, only ICD-9-CM codes are required . No mapping is necessary. For a period of up to two years, systems will need to access both ICD-9-CM codes and ICD-10-CM codes as the country transitions from ICD-9-CM to ICD-10-CM. Mapping will be necessary so that equivalent codes can be found for issues of disease tracking, medical necessity edits and outcomes studies.

Winning in Business…just “Do It”

March 19, 2011

Art Williams spoke at the 1987 National Religious Broadcast Convention and you can watch the video clip here.  I took notes on some of the highlights that I want to remember and think about:

How to Win in Business

You first have to find a need.  You have to be able to fulfill the consumer need.  You have to know you market, someone to sell your product or service to.  You have to have a uniqueness.  You can do 99% of the things right but if you don’t do that 1%, you will fail.  No test measures the heart of a man or woman…they are not outside artificial things.  The key is what is what is inside a person.  It is your integrity, your people abilities, your character… develop a winning edge.

1. get excited, be positive, enthusiastic and tough

2. you got to be a dreamer, again

3. don’t say I can’t

4. stand for something

5. yes, you will be controversial, if you don’t want to be controversial then you will just be average and ordinary

6. make a total commitment to what you are about…you will have lots of false starts, pick yourself back up, you got to go for it one more time which will determine your success or failure, you can’t just stick your toe in it

7. treat people good, get to know them, love them, care about them

8. establish the right kind of priorities, you can not separate your personal and business life, have tunnel vision:  God must come First, Family Second, Business Third…long range it will be devastating to your business if this is not the order of your priorities

9.  you can’t quit, have a desire and will to win, pay the price a little bit more

10.  be a leader, do whatever it takes, just do it, do it, do it


March 17, 2011

“Try, try, try, and keep on trying is the rule that must be followed to become an expert in anything.”  -W Clement Stone

What is an Advanced Beneficiary Notice (ABN)?

March 14, 2011
ABN (Advanced Beneficiary Notice):  

An ABN is a written notice from Medicare (standard government form CMS-R-131), given to you before receiving certain items or services, notifying the patient:

• Medicare may deny payment for that specific procedure or treatment.

• The patient will be personally responsible for full payment if Medicare denies payment.

An ABN gives the patient the opportunity to accept or refuse the items or services and protects the patient from unexpected financial liability in cases where Medicare denies payment. It also offers the patient the right to appeal Medicare’s decision. You follow office policy on keeping the ABN form on file and you ad the modifier GA to the claim. Modifier GA informs Medicare of the ABN transaction. If you do not have the patient sign the ABN form and the claim is denied, then you cannot bill the patient for the denied claim.

The patient has the option to receive the items or services or to refuse them. In either case, the patient should choose one option on the form by checking the box provided, and then signing and dating it in the space provided.

When the patient signs an ABN and becomes liable for payment, the patient will have to pay for the item or service themselves, either out-of-pocket or by some other insurance coverage which they may have in addition to Medicare. Medicare fee schedule amounts and balance billing limits do not apply. The amount of the bill is a matter between the patient and provider. If this is a concern for the patient, they might want to ask for a cost estimate before they sign the ABN.


March 10, 2011

“There is only one boss. The customer. And he can fire everybody in the company from the chairman on down, simply by spending his money somewhere else.”  -Sam Walton

The 5 Keys to Memory

March 9, 2011

Today, I attended my networking group with Untyed.  The speaker was Ron White, the current USA Memory Champion.  He has the record for memorizing the most numbers in five minutes and the fastest to memorize a deck of cards.

People struggle at remembering isn’t because you have a bad memory it is because you aren’t listening.  You are thinking of you, what you are going to say, what comes next, and you are not paying attention.  He spoke on The 5 Keys to Memory.  He states that usually your favorite subject is yourself and your favorite sound is your name.  He referenced the book How To Win Friends and Influence People by Dale Carnegie. He also quoted Zig Ziglar:  “People don’t care what you know till they know you care.”  Our #1 Fear is speaking.  Our #2 Fear is death.

He then had each of us in the room give him some two digit numbers…here they are:

89 16 24 16 44 32 46 23 92 34 29 15 77 27 10 99 64 31 87 21 43 12 43 18 52

He went on with his speech…

5 Keys to Memory:

  • Focus = Listen & Pay Attention
  • File = Information is always in your head, use 5 to 10 files (put it in its spot, don’t just store it in your head)
  • Picture = Put words to items that will be a vivid picture, involve all your senses (your mind will remember more what it sees when you connect it with something)
  • Glue = Action and Emotion  (this helps your remember events when something is attached to it and cemented, passive stuff doesn’t stay in your memory)
  • Review = Rehearse this process (this is how you get good at it)

He then repeated back each of these numbers in order completely.  That not impress you?  He repeated them backwards exactly?  How about then asking you a number between 1 and 25 and he told you what double digit number was at that spot in the set listed above.  Beyond impressive.  You can see a demo of the deck of cards here and he also demonstrates as he did in this speech yesterday reciting back numbers.  If you haven’t been impressed enough yet, check out this link for The Mathematical Genius, Daniel Tammet, who read a string of numbers once and repeated it back in 5 hours and 9 minutes with 100% accuracy!!!!!!!

Want help and information on “How to Remember Names“?

Speaker Ron White’s website and

7 Things Every Medical Biller Should Know

March 7, 2011

1.       Rules & Regulations

Have an understanding of the rules and regulations set forth by each and every entity: 

  • Centers for Medicare & Medicaid Services (CMS)
  • American Medical Association (AMA)
  • Health Insurance Portability and Accountability Act (HIPAA)
  • Office of Inspector General (OIG)
  •  State Laws (per your state) – a resources for Texas:  Texas Department of Insurance (TDI), Texas Medical Board (TMB), Texas Medical Association (TMA), and Tarrant County Medical Society (TCMS)
  • US Department of Health and Human Services (HHS)
  • The Fair Debt Collection Practices Act (FDCPA)
  • Protected Health Information (PHI)
  • Insurance Payers specifications & regulations
  • Prompt Pay Act



2.       Obtain Copies of your Insurance Contracts

The importance of having copies of your contracts with the payer’s is so that you are aware of the physician’s legal obligations, agreed upon terms, and defined requirements to ensure that you adhere to their specific regulations.  It also defines other pieces of information that are helpful to you in dealing with medical claims.


3.       Make a list of your top 10 or 20 CPT Codes

This enables you to already have prepared your top codes when either an insurance company requests it or to submit to an insurance company to obtain their contract rates if you don’t otherwise have them.  Make sure that this procedure code list is current and up-to-date.


4.       Medical Terminology

Be familiar with the medical terminology of your field or practice specialty.  Research all the information available regarding the specific specialty of your practice.  This will provide you with an extensive amount of resources, knowledge at knowing the when, where, why & how’s for treatment, testing, medication, etc.  This will be a benefit to your advantage when you are trying to explain details and/or resolve issues with either insurance companies, patients or other entities.


5.       The Importance of Accuracy

Accuracy and attention to detail are key aspects of a medical biller’s success.  Accuracy affects the charge entry, claims processing, payment processing, appeals and collections processes.  If your data and processes are not accurate, you will spend exorbitant amounts of time, energy and even money tracking and pursuing claims.  You must be attentive and accurate in every aspect of the process to be efficient and effective in your role as a medical biller.


6.       Requires Organization and Persistence

Medical Billing requires that you be organized.  You need to know where all your files are kept, keep an original of all forms required, create a process with procedures in place to accomplish all duties from start to finish, and attend to the smallest details.

Medical Billing requires persistence on every level.   Pushing things off to a later date, letting things slide as not being important, giving up when you know the data you have is accurate, and not providing follow thru will not only hurt the reimbursement for you and your physician, it creates unnecessary issues and further paperwork along with additional follow-up which can be prevented.


7.       Read all literature you run across

We all get inundated with paperwork, newsletters and articles.  Remember that it is very important that you stay informed on the updates that are produced by various networks, organizations and companies.  Use this to your advantage so you never are caught unprepared or uneducated.


Utilize these 7 steps and you will have a foundation for becoming an excellent Medical Biller!  We wish you great success!  If we can assist you further, please to not hesitate to contact us at 817.239.6595.


March 3, 2011

“There are no secrets to success. It is the result of preparation, hard work, and learning from failure.”  -Colin Powell